| Sidewalk Blooming, Llc | |
|
2355 State St Ste 101 Salem OR 97301-4541 | |
| (503) 427-8135 | |
| Not Available |
| Full Name | Sidewalk Blooming, Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 2355 State St Ste 101, Salem, Oregon |
| Authorized Official Name and Position | Katelin Westfall (OWNER) |
| Authorized Official Contact | 5034278135 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Sidewalk Blooming, Llc 4207 Se Woodstock Blvd # 241 Portland OR 97206-6267 Ph: () - | Sidewalk Blooming, Llc 2355 State St Ste 101 Salem OR 97301-4541 Ph: (503) 427-8135 |
| NPI Number | 1225735905 |
|---|---|
| Provider Enumeration Date | 02/13/2023 |
| Last Update Date | 02/13/2023 |
| Certification Date | 02/10/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225735905 | NPI | - | NPPES |
| 500783580 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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